A paradox in healthcare service development: professionalization of service users

Policy makers increasingly regard user involvement as an important dimension of service development. However, research suggests user involvement is often unrepresentative and tokenistic. Drawing on an in-depth case study in mental health carried out in 2008-2012, we examine the processes that give rise to unrepresentative service user involvement. We show that through a combination of self-selection by those wanting to be involved, and professionals actively selecting, educating and socializing certain users, unrepresentative involvement occurs. The selected users tend to be more articulate and able to work with professionals, and are complicit in the processes which give rise to unrepresentative involvement. They pursue their own professional status by delineating a distinctive body of 'expert' management knowledge that bounds their jurisdiction, and from which they can exclude those they perceive as 'less expert' users.